ONE TOUR OF DUTY TOO FAR - THE PROBLEM OF „DOUBLE” ON-CALL DUTY FOR RESIDENT DOCTORS DOUBLE ON-CALL TIME FOR RESIDENT DOCTORS 23 October 2020
In the face of the pandemic, much has been said about the need to duly thank doctors for their efforts to combat the virus threatening us all. At the same time, it has been somewhat forgotten that doctors, especially those just starting their careers, are constantly faced not only with medical challenges, but also with other, more mundane difficulties - in particular, they are confronted with the need to be on duty at the same time in the emergency room (or ED) and another hospital ward.
Recently, the Law Firm, addressed a letter of advocacy to the Hospital, where such practices were taking place, for the reorganisation of on-call duties. As a result of these actions, the doctor represented by the Law Firm was guaranteed the possibility to perform medical on-call duties in accordance with the regulations in force in this respect. This case proves that resident doctors do not have to accept the imposition of excessive and unlawful duties on them.
As such situations are, unfortunately, not uncommon, it is worth pointing out that the indicated organisation of on-call medical services leads to a violation of both the rights of the patient and of the doctors themselves, if only because of the significant increase in the risk of them making a mistake when providing medical assistance.
In accordance with Article 8, sentence 1 of the Act on Patients' Rights and Patients' Ombudsman the patient has the right to health services provided due diligence by healthcare providers in conditions corresponding to the professional requirements specified in separate regulations and sanitation.
There can be no doubt that doctors who are confronted with the need to provide medical assistance simultaneously in, for example, various hospital wards, for objective reasons, are not in a position - even when exercising the required diligence in the management of each case - to guarantee proper care to all patients entrusted to them in this way, all the while remaining a guarantor of their health and life under criminal law.
Consequently, it must be concluded that this organisation of the hospital's work violates the general precautionary principles that are required to be observed during the process of providing all health services, which also has a direct negative impact on the operation of the hospital, as it is The hospital, and not its employees or recipients, provides treatment services[1]. The obligation to perform concurrent medical on-call duty must therefore be assessed at the level of the organisational fault, which places the burden not on resident doctors but on those responsible for the operation of hospitals.
The doctrine identifies precisely (i) the lack of an adequate number of experienced doctors and specialists for the hospital's operation, (ii) the delay in providing medical assistance as the main causes of organisational fault (errors)[2] and inadequacies concerning: (iii) safeguarding the organisation of the patient's treatment on the ward, (iv) whether the 24-hour medical and nursing care of the patient[3].
„Double” or „parallel” on-call duties are also disadvantageous for patients and the hospital itself also because of the higher risk of spreading the SARS-CoV-2 virus, which is all the more likely in such a situation to be „transferred” from the emergency room or ED to the ward (or vice versa), not even mentioning the doctors and other staff.
The analysed situation also contradicts the provisions regulating the rules of specialisation. Indeed, according to Article 16f(1) of the Act on the professions of physician and dentist: 1. A doctor undergoes specialisation training on the basis of the specialisation programme established for the field of specialisation in question Medicine, taking into account the relevant module. Paragraph 3h of the cited provision, on the other hand, states that: the specialisation programme shall include performing medical on-call duties as defined in the specialisation programme.
As can be seen from the provisions cited above, the essence of medical on-call performed during specialisation is that it is limited to the field covered by the programme in question. A resident doctor cannot therefore be forced to perform medical on-call duties outside of his or her specialty programme [4].
A critical stance towards the different practice of forcibly directing resident doctors to be on-call in emergency rooms or EDs has already been expressed many times by representatives of the Ministry of Health.
Namely, it was found that The secondment of a doctor to work in a department other than the one provided for in the specialisation programme is incompatible with the agreement concluded with the Minister of Health to reimburse the costs of employing residents, and this, according to § 2(5) of the aforementioned agreement, entails repayment of funds provided by the Minister of Health for its implementation” (vide Letter from the Department of Science and Higher Education of the Ministry of Health of 1 July 2014, MZ-NSK-842-4262-1/MŚ/14, addressed to the Young Doctors Committee of the Supreme Medical Council, cf. also Communication on on-call duty for doctors undergoing specialised training[5]).
This issue has also been the subject of sustained attention by national Chambers of Physicians, as expressed, inter alia, in an open letter from the President of the Warsaw Regional Medical Council, which included the following comments: In a legal opinion obtained by us from the Department of Science and Higher Education of the MZ [indicated that - own interjection]. on-call duty in the ED, if not included in the specialty programme, may be performed only with the consent of the doctor concerned, under a separate contract for medical services, provided that it does not hinder the completion of the specialty training programme[6].
In view of the above, it should be emphasised that hospitals and other medical service providers should cease the blatantly abusive practices described and ensure that on-call medical services are organised in a way that is compatible with both patient and doctor rights. Undoubtedly, the actions lege artis are also in the interest of these medical entities and their managers, who are, after all, legally responsible for both patients and their employees.
[1] See the judgment of the Courts of Appeal in Lublin of 17 February 2016 ref. III AUa 974/15.
[2] See A.Engler-Jakubiak, Organisational medical error.
[3] See B.Pawelczyk, Tort liability of a health care institution for the actions of the director and chief executive officer.
[4] See M.Kopeć, Act on the professions of physician and dentist. Commentary.
[5] https://www.gov.pl/web/zdrowie/komunikat-w-sprawie-pelnienia-dyzurow-medycznych-przez-lekarzy-odbywajacych-szkolenie-specjalizacyjne.
[6] https://izba-lekarska.pl/numer/numer-8-92014-2/list-otwarty-w-sprawie-dyzurow-na-sor/
In the face of the pandemic, much has been said about the need to duly thank doctors for their efforts to combat the virus threatening us all. At the same time, it has been somewhat forgotten that doctors, especially those just starting their careers, are constantly faced not only with medical challenges, but also with other, more mundane difficulties - in particular, they are confronted with the need to be on duty at the same time in the emergency room (or ED) and another hospital ward.
Recently, the Law Firm, addressed a letter of advocacy to the Hospital, where such practices were taking place, for the reorganisation of on-call duties. As a result of these actions, the doctor represented by the Law Firm was guaranteed the possibility to perform medical on-call duties in accordance with the regulations in force in this respect. This case proves that resident doctors do not have to accept the imposition of excessive and unlawful duties on them.
As such situations are, unfortunately, not uncommon, it is worth pointing out that the indicated organisation of on-call medical services leads to a violation of both the rights of the patient and of the doctors themselves, if only because of the significant increase in the risk of them making a mistake when providing medical assistance.
In accordance with Article 8, sentence 1 of the Act on Patients' Rights and Patients' Ombudsman the patient has the right to health services provided due diligence by healthcare providers in conditions corresponding to the professional requirements specified in separate regulations and sanitation.
There can be no doubt that doctors who are confronted with the need to provide medical assistance simultaneously in, for example, various hospital wards, for objective reasons, are not in a position - even when exercising the required diligence in the management of each case - to guarantee proper care to all patients entrusted to them in this way, all the while remaining a guarantor of their health and life under criminal law.
Consequently, it must be concluded that this organisation of the hospital's work violates the general precautionary principles that are required to be observed during the process of providing all health services, which also has a direct negative impact on the operation of the hospital, as it is The hospital, and not its employees or recipients, provides treatment services[1]. The obligation to perform concurrent medical on-call duty must therefore be assessed at the level of the organisational fault, which places the burden not on resident doctors but on those responsible for the operation of hospitals.
The doctrine identifies precisely (i) the lack of an adequate number of experienced doctors and specialists for the hospital's operation, (ii) the delay in providing medical assistance as the main causes of organisational fault (errors)[2] and inadequacies concerning: (iii) safeguarding the organisation of the patient's treatment on the ward, (iv) whether the 24-hour medical and nursing care of the patient[3].
„Double” or „parallel” on-call duties are also disadvantageous for patients and the hospital itself also because of the higher risk of spreading the SARS-CoV-2 virus, which is all the more likely in such a situation to be „transferred” from the emergency room or ED to the ward (or vice versa), not even mentioning the doctors and other staff.
The analysed situation also contradicts the provisions regulating the rules of specialisation. Indeed, according to Article 16f(1) of the Act on the professions of physician and dentist: 1. A doctor undergoes specialisation training on the basis of the specialisation programme established for the field of specialisation in question Medicine, taking into account the relevant module. Paragraph 3h of the cited provision, on the other hand, states that: the specialisation programme shall include performing medical on-call duties as defined in the specialisation programme.
As can be seen from the provisions cited above, the essence of medical on-call performed during specialisation is that it is limited to the field covered by the programme in question. A resident doctor cannot therefore be forced to perform medical on-call duties outside of his or her specialty programme [4].
A critical stance towards the different practice of forcibly directing resident doctors to be on-call in emergency rooms or EDs has already been expressed many times by representatives of the Ministry of Health.
Namely, it was found that The secondment of a doctor to work in a department other than the one provided for in the specialisation programme is incompatible with the agreement concluded with the Minister of Health to reimburse the costs of employing residents, and this, according to § 2(5) of the aforementioned agreement, entails repayment of funds provided by the Minister of Health for its implementation” (vide Letter from the Department of Science and Higher Education of the Ministry of Health of 1 July 2014, MZ-NSK-842-4262-1/MŚ/14, addressed to the Young Doctors Committee of the Supreme Medical Council, cf. also Communication on on-call duty for doctors undergoing specialised training[5]).
This issue has also been the subject of sustained attention by national Chambers of Physicians, as expressed, inter alia, in an open letter from the President of the Warsaw Regional Medical Council, which included the following comments: In a legal opinion obtained by us from the Department of Science and Higher Education of the MZ [indicated that - own interjection]. on-call duty in the ED, if not included in the specialty programme, may be performed only with the consent of the doctor concerned, under a separate contract for medical services, provided that it does not hinder the completion of the specialty training programme[6].
In view of the above, it should be emphasised that hospitals and other medical service providers should cease the blatantly abusive practices described and ensure that on-call medical services are organised in a way that is compatible with both patient and doctor rights. Undoubtedly, the actions lege artis are also in the interest of these medical entities and their managers, who are, after all, legally responsible for both patients and their employees.
[1] See the judgment of the Courts of Appeal in Lublin of 17 February 2016 ref. III AUa 974/15.
[2] See A.Engler-Jakubiak, Organisational medical error.
[3] See B.Pawelczyk, Tort liability of a health care institution for the actions of the director and chief executive officer.
[4] See M.Kopeć, Act on the professions of physician and dentist. Commentary.
[5] https://www.gov.pl/web/zdrowie/komunikat-w-sprawie-pelnienia-dyzurow-medycznych-przez-lekarzy-odbywajacych-szkolenie-specjalizacyjne.
[6] https://izba-lekarska.pl/numer/numer-8-92014-2/list-otwarty-w-sprawie-dyzurow-na-sor/